Choosing Wisely:

Don’t routinely obtain a CT or MRI scan for infants with macrocephaly who are developmentally normal and clinically asymptomatic.

Rationale and Comments: Most infants with macrocephaly do not have abnormalities that require neuroimaging or neurosurgical evaluation. Imaging should generally be reserved for infants with clinical concerns such as abnormal neurological examination findings, significant developmental delay, or rapidly increasing head circumference measurements (such as those crossing growth curves). When imaging is indicated, head ultrasonography should typically be considered as the first-line test for infants with an open fontanelle.
Sponsoring Organizations:
  • American Academy of Pediatrics – Section on Neurological Surgery
  • Sources:
  • Retrospective cohort study
  • Disciplines:
  • Pediatric
  • Neurologic
  • Neonatology
  • References: • Haws ME, Linscott L, et al. A retrospective analysis of the utility of head computed tomography and/or magnetic resonance imaging in the management of benign macrocrania. J Pediatr. 2017;182:283-289.e1.
    • Sampson MA, Berg AD, et al. Necessity of intracranial imaging in infants and children with macrocephaly. Pediatr Neurol. 2019;93:21-26.

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